Claims Specialist
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Accentuate Staffing has an immediate direct hire, hybrid Claims Specialist opportunity with an established annuity claims company. Recent college graduates are encouraged to apply? The Claims Specialist will be responsible for the evaluation, investigation, and resolution of life and annuity claims, perform diverse duties relating to the intake, processing, review, and adjudication of claims, including reviewing for accuracy, file and claim completeness, reviewing coverage and approving payment or denial.
Responsibilities:
- Evaluate and determine claim coverage for benefits in accordance with policy and/or certificate provisions, and department procedures.
- Verify and analyze data used in settling claims to ensure that claims are valid and that settlements are made according to company practices and procedures.
- Establish claim reserves and authorize payments within authority limits.
- Enter claim payments, reserves, and new claims on various computer programs, inputting concise yet sufficient file documentation.
- Contact and/or interview claimants, doctors, medical specialists, or employers to obtain additional information as needed.
- Manage time adequately to ensure proper turn around for all tasks such as new claims, pending claims, customer service requests, and audit feedback.
- Maintain quality and production standards as defined by procedures and management.
- Communicate with legal counsel on claims requiring litigation.
- Maintain claim files, such as records of settled claims and an inventory of claims requiring detailed analysis.
- Report overpayments, underpayments, and other irregularities.
- Ability to look at processes and offer suggestions for efficiencies.
- Work with teammates and supervisor to ensure the needs of the claimants are being met.
- Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
- Maintain complete confidentiality of company business.
- Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested.
- Comply with HIPAA, Diversity Principles, Corporate Integrity, Compliance Program policies and other applicable corporate and departmental policies.
Requirements:
- Bachelor’s Degree is required.
- One year of claims adjudication or equivalent experience.
- Must have NC Life License – will allow 90 days to obtain and will cover cost associated with examination.
- Complete FMLI Level 1 LOMA course and ACS course within 9 months of employment.
- Clear and concise verbal and written communication skills.
- Analytical, problem solving and organizational skills.
- Attention to Detail and Highly Dependable.
- Proficiency with MS Office applications, especially Word and Excel.
